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HAM-D — Hamilton Depression Rating Scale

Hamilton, 196017 items · single scale5–15 min (interview)Clinician-rated · research standardRU · EN
CalculatorCut-offsAboutFAQ
CalculatorAboutCut-offsClinical useSourcesFAQ

What HAM-D measures

The Hamilton Depression Rating Scale (HAM-D, HDRS-17) is the oldest and most widely used clinician-rated measure of depression severity. The clinician scores 17 items — affective, cognitive, and somatic — from a structured clinical interview rather than patient self-report.

Nine items are scored 0–4 and eight items 0–2, giving a single total score from 0 to 52. Unlike self-report scales such as PHQ-9 or BDI-II, HAM-D is completed by a specialist and reflects observed as well as reported symptoms.

HAM-D grades the severity of an already-established depressive condition; it is not a diagnostic or screening instrument and does not establish a diagnosis on its own.
Each item is scored on its own range (0–4 or 0–2). The total ranges from 0 to 52. Assessment covers the past 7 days. The scale is completed by a clinician, not the patient.

Severity cut-offs

HDRS-17 — total-score severity bands (per Zimmerman, 2013)
Score rangeSeverityClinical meaning
0–7No depression / remissionNo depression / remission range
8–16Mild depressionMild depression
17–23Moderate depressionModerate depression
24–52Severe depressionSevere depression

Use in clinical practice

HAM-D is used to grade baseline severity and to monitor change over the course of treatment. It is the de facto standard primary outcome in antidepressant trials.

Baseline severity

The total score places the patient in a severity band (remission, mild, moderate, severe), informing the intensity of the treatment plan.

Monitoring response

Repeat every 1–2 weeks using a structured interview (SIGH-D / GRID-HAMD). A ≥50% reduction from baseline defines treatment response; a total ≤7 defines remission.

The scale weights somatic and anxiety symptoms heavily — keep this bias in mind when interpreting totals in patients with physical comorbidity.

Sources

  • Hamilton M. A rating scale for depression. Journal of Neurology, Neurosurgery & Psychiatry. 1960;23:56–62.
  • Hamilton M. Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology. 1967;6(4):278–296.
  • Williams JBW. A structured interview guide for the Hamilton Depression Rating Scale (SIGH-D). Archives of General Psychiatry. 1988;45(8):742–747.
  • Williams JBW, Kobak KA, et al. The GRID-HAMD: standardization of the Hamilton Depression Rating Scale. International Clinical Psychopharmacology. 2008;23(3):120–129.
  • Zimmerman M, Martinez JH, Young D, et al. Severity classification on the Hamilton Depression Rating Scale. Journal of Affective Disorders. 2013;150(2):384–388.
  • Bagby RM, Ryder AG, Schuller DR, Marshall MB. The Hamilton Depression Rating Scale: has the gold standard become a lead weight? American Journal of Psychiatry. 2004;161(12):2163–2177.
HAM-D calculator
0 of 17 items scored17 items left
Depressed mood (sadness, hopeless, helpless, worthless)
Feelings of guilt
Suicide
Insomnia: early (difficulty falling asleep)
Insomnia: middle (restless, disturbed night)
Insomnia: late (early-morning waking)
Work and activities
Retardation (slowing of thought, speech, activity)
Agitation
Anxiety (psychic)
Anxiety (somatic): physiological concomitants — GI, palpitations, headache, hyperventilation
Somatic symptoms (gastrointestinal)
Somatic symptoms (general)
Genital symptoms (loss of libido, menstrual disturbance)
Hypochondriasis
Loss of weight
Insight
Total score (HDRS-17)0 / 52

Clinical use of HAM-D

Questions about scoring, severity bands, and the scale's limits

HAM-D is clinician-rated and scored from a structured interview, while PHQ-9 is a patient self-report. HAM-D covers somatic and anxiety symptoms more broadly and is the research standard for grading severity; PHQ-9 is a quick screen and self-monitoring tool.
Treatment response is conventionally defined as a reduction of 50% or more from the baseline total score. Remission is usually defined as a total score of 7 or below.
This is by design (Hamilton, 1960): symptoms that can be graded reliably are scored 0–4, while symptoms that are harder to quantify are scored 0–2. The total still ranges from 0 to 52.
No — HAM-D is clinician-rated. Several items (retardation, agitation, insight) depend on the clinician's observation during an interview. For self-completion, use PHQ-9 or BDI-II instead.
Hamilton (1960) did not define official severity bands. The 7 / 16 / 23 thresholds were validated by Zimmerman et al. (2013) and are a clinical reference, not a diagnostic rule.
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Used together with HAM-D

Depression · clinician-rated
MADRS

An alternative clinician-rated depression scale with less somatic weighting and high sensitivity to change. Often used in place of HAM-D.

Coming soon
Depression · self-report
PHQ-9

A self-report scale for screening and self-monitoring. Complements HAM-D from the patient's perspective.

Coming soon
Anxiety / Depression
HADS

A self-report scale without somatic items. Useful when physical symptoms would distort a depression rating.

Open
This tool is intended for mental-health professionals. HAM-D is completed by a clinician from a clinical interview and is not designed for patient self-completion. The assessment period is the past 7 days. Results are informational, do not replace clinical judgment, and are not a diagnosis.
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